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Type:	Artigo de Periódico
Title:	Posterior urethral valves: comparison of clinical outcomes between postnatal and antenatal cohorts
Authors:	Mariana Affonso Vasconcelos R. H. Mak Eduardo a. Oliveira A. C. Simões e Silva Cristiane Dos Santos Dias I. R. Gomes S. V. Figueiredo M. C. L. Oliveira R. A. Carvalho T. R. Dumont S. V. Pinheiro
Abstract:	Background:Posterior urethral valves (PUVs) constitute the most common infravesical urinary obstruction in boys and are often accompanied by severe consequences to the lower and upper urinary tract. Currently, about two-thirds of diagnosis of PUVs has been suspected by prenatal ultrasonography findings. The aim of this study was to compare long-term clinical outcomes in two groups of patients with PUVs, with antenatal vs.postnatal diagnosis.Study design:This was a retrospective cohort study of 173 patients with PUVs systematically followed up in a tertiary center. Median follow-up time was 66.5 months (interquartile range [IQ], 11.4e147.9 months) for those patients who survived neonatal period. Seventy-nine (45.6%) patients were fol lowed up for more than 5 years and 55 (32%) for more than 10 years. For analysis, the cohort was stratified into two groups according to the clinical presentation (prenatal vs. postnatal). The events of interest were urinary tract infection (UTI), surgical interventions, proteinuria, hypertension, chronic kidney disease (CKD), and death. Survival analyses were performed to evaluate time until occurrence of the events.Results:Sixty-two patients (35.8%) were diagnosed by fetal sonography. Patients of postnatal group presented a higher incidence rate of UTI episodes (6.5, 95% confidence interval [CI], 4.9e8.3) than antenatal group (1.2, 95% CI, 0.4e2.7) (P < 0.001). Thirty-six patients (21%) presented hypertension, and 77 (44.5%) had persistent mild proteinuria. There was no significant difference in the estimated incidence of hypertension (P Z 0.28) and proteinuria (P Z 0.78) between antenatal and postnatal groups. The cumulative incidence of CKD stage 3 was estimated to be about 37% at 10 years of age, and 56% at 18 years of age. By survival analysis, there was no significant difference in the estimated incidence of CKD stage 3 (log-rank Z 0.32, P Z 0.57) and CKD stage 5 (log-rank Z 1.08, P Z 0.28, Figure) between antenatal and postnatal groups. Of 173 patients included in the analysis, 13 (7.5%) died during follow-up with a median age of 2.6 months(IQ, 15 dayse62 months). Survival analyses have not shown any significant difference in the estimated incidence of death between antenatal and postnatal groups (log-rank Z 1.38, P Z 0.24).Conclusion: The study findings did not corroborate the initial hypothesis that the rates of renal function declining in patients with PUVs would be attenuated by an early diagnosis and intervention after antenatal diagnosis.
Subject:	Infecções Urinárias Insuficiência Renal Crônica Hipertensão
language:	eng
metadata.dc.publisher.country:	Brasil
Publisher:	Universidade Federal de Minas Gerais
Publisher Initials:	UFMG
metadata.dc.publisher.department:	MED - DEPARTAMENTO DE PEDIATRIA
Rights:	Acesso Restrito
metadata.dc.identifier.doi:	https://doi.org/10.1016/j.jpurol.2018.11.005
URI:	http://hdl.handle.net/1843/57390
Issue Date:	24-Nov-2018
metadata.dc.url.externa:	https://www.sciencedirect.com/science/article/pii/S1477513118304297?via%3Dihub
metadata.dc.relation.ispartof:	Journal of Pediatric Urology
Appears in Collections:	Artigo de Periódico

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